Political spin about ‘so many’ UHL consultants is pathetic

Government mantra shows the difference between ‘the truth’ and ‘the whole truth’

The circumstances leading to the tragic, and almost certainly avoidable death of Aoife Johnston at University Hospital Limerick (UHL) were laid bare at last month’s inquest, with a verdict of death by medical misadventure. The evidence given by Aoife’s family and the hospital was harrowing.

HSE chief executive Bernard Gloster was characteristically upfront in accepting and apologising unreservedly for the failure of the health service to provide Aoife with the care that she needed. There seems little room for doubt about his sincerity or his determination to make things better.

UHL has been challenged for many years in meeting the needs of its patients. The emergency department has long been among the biggest contributors to the daily trolley count — and the problem has been getting worse. Congestion, long waiting times, staff under pressure and poor patient experiences is, unfortunately, nothing new.

The considerable investments in new infrastructure, a new emergency department, new beds and additional staff have not been enough to close the gap between what people in the mid-west need and are entitled to expect — and what they have.

Actions to address the resource and performance issues in Limerick must be evidence-based and sufficient. Anything else is destined to failure.

The choreographed political response to the inquest was heartbreakingly disappointing.

Readers will recall the repeated assertions that Limerick “has more emergency consultants than any other hospital” — parroted as part of a communications strategy designed to convince us the problem is not about resources, but rather about performance and management. It was basically politicians saying: “Don’t look at us, look at the HSE and its poor use of resources.”

It is true that with 11.5 whole-time equivalent (WTE) emergency medicine (EM) consultants, Limerick has more than any other hospital — but it is a meaningless fact, devoid of context or relevance. It exemplifies the difference between “the truth” and “the whole truth”.

The Royal College of Emergency Medicine advises that one EM consultant is needed for every 3,6004,000 patient presentations per year. In the whole of our health service, we are well behind that ratio.

Last year, Limerick had 80,113 A&E attendances, plus another 46,704 in its local injury units. A&E attendances in Limerick are up by 12pc in the first four months of this year, and the numbers presenting at local injury units was up by 6pc in the first quarter. Hospital admissions from A&E were up by 14pc in January to April.

As per the Royal College of Emergency Medicine ratio, the appropriate quota of EM consultants in Limerick (based on 2023 activity levels) is in the 31.5-35 range. By that measure, Limerick, with its 11.5 EM consultants, has a mere third of the number it needed to manage its workload last year.

Even if local injury unit patients were excluded from calculations, the number of EM consultants required is close to twice the existing number.

Growth in the population, changes in age profile and the sudden arrival of people fleeing war in Ukraine are all driving A&E presentations and hospital admissions upwards, on a more or less continuous basis.

The political mantra that Limerick’s troubles are hard to understand when they have “so many” ED consultants looks just a tiny bit pathetic when tested on an evidence-informed basis.

In truth, the Government’s talking points being used against the hospital are more an admission of failure than the political defence they were designed to be. But they also point to a dangerous complacency that does nothing for morale at Limerick — where staff are under severe pressure and a number of them are out on sick/ stress leave.

There is a marked increase in A&E attendances nationwide this year, and it is believed to be associated with a growing lack of availability of sameday appointments in primary care, leaving too many patients with nowhere else to go but A&E.

This push intensifies the overcrowding of A&Es, which in turn leaves the under-resourced medical teams (in the words of one leading ED consultant) “trying to catch the sicker patients in a bigger crowd”.

Given this reality, the health system is faced with hard decisions about what it should now prioritise. General practice is under pressure, and access to GP care is becoming more constrained across the country.

At the moment, as part of national strategy, GPs are being incentivised and rewarded for participating in chronic disease management, but not for same-day unscheduled care. I have previously written about the success of the Chronic Disease Management Programme. But an unintended consequence is that unscheduled care work is now defaulting to A&Es.

Other countries, such as the UK, have widespread urgent care centres. In Ireland these exist as part of Children’s Health Ireland and in the private sector. We are faced with either finding a way of paying and incentivising GPs for same-day unscheduled care in the hope it will reduce A&E workload, or creating well-resourced urgent care centres co-located with A&Es — as has happened in Britain.

In a joint foreword to the recently published analysis of hospital performance, Robert Watt and Bernard Gloster wrote: “The identified divergence between resourcing and performance is a major concern. We must respond coherently with clarity on how targeted investment can be made to improve service delivery in the acute setting. In doing so we will listen to staff who are best placed to identify where change can be delivered.”

They committed to being “as open and transparent as possible. Not to facilitate blame, but to encourage and support improvements”.

The data they published has many important nuances and caveats, but, like the misleading “argument” that Limerick has more EM consultants than any other hospital, it has been seized upon by some as a basis for arguing against further investment in Health, in an effort to set up another damaging budget round this year.

If that happens, there is little hope of addressing the real needs in the mid-west — or elsewhere.